Training Others: Presentation Content and Materials for Various Audiences

Whether training a small group or a large audience, a highly interactive presentation is wise—it keeps participants engaged and the content personalized and relevant. So here are some strategies organized by the likely focus of presentations.

Note: If using our slide shows, there are comments (turn on the Notes pages to see these) to help you explain the content.

Encouraging Use of Quality Measures/Exposure to Tool Options/and Screening in an Electronic Environment

1. Start out with the “Why Screen” slide show which helps encourage providers to use quality tools AND offers brief exposure to various tool options. Attendees prefer to have a copy of the slide show so they can follow along and jot down highlights. It is ideal to print the slide show, 3 to a page with space on the right. You don't need to print the presenter's notes pages, those are to aid you in your presentation.

2. Show our PEDS+PEDS:DM and PEDS Online videos to illustrate how our tools work. Note: If you expect a large audience to also hear the voice-over, you’ll need to make sure your AV person mics your computer. If that’s not possible, you can provide your own voice-over but if so, you’ll need to get super- familiar with the content so you can paraphrase what’s said.

3. Provide printed copies of our case examples and work through them (this is also a good time to discuss how to deliver difficult news and what resources are available to help families.

4. Pause often for questions and discussion about optimal responses to a family’s concerns/child’s performance, local resources, etc.

5. If training on PEDS, work through additional cases (you can use our slide shows) and participants can rescore on the PEDS case example (blank PEDS Forms may not be used for training because these tend to “walk” and participants end up with bits and pieces but no Brief Guide to Scoring—major problem). An alternative, if your audience knows they want to use PEDS, is to purchase a complete set for each participant (and charge an extra fee for your conference to cover the cost).

6. If training on the PEDS:DM you may photocopy 2 or so pages of questions (but not all pages of questions). The PEDS:DM scoring template does not copy well (and the size distortions created by photocopying means that the template won’t work perfectly). So, you’ll have to demonstrate use of the scoring template within your slide show (ours are animated and show the template being placed over the PEDS:DM questions and how progress is tracked on the PEDS:DM Recording Form). You can also pass around your copy of the PEDS:DM so folks can at least handle it (but be sure to get it back at the end of your session). If your audience knows in advance they want to use the PEDS:DM, you can purchase a set for each. Or… if you have multiple copies available, you can have participants break up into small groups so they can share a single copy. Hands-on is most helpful with the PEDS:DM.

7. Most riveting is to ask someone in the audience to offer a new case (be sure they do not reveal their relationship to the child described so that group discussion about how to handle results is unimpeded).

8. Leave lots of time for questions (and prepare for likely questions by reading through and having available to you the FAQs on our site). If you have an internet connection, you can show your audience where to find the FAQs on our site.

9. If training health care providers, cover billing/coding issues briefly (we have this in our Implementation slide show and in the billing/coding menu on our home page). Prompt for discussion about how to implement screening in primary care. You may want to make full-size photocopies of the slides devoted to work-flow options so that participants can consider options and create their own plans.

10. If implementation involves electronic records, be sure to show the PEDS Online video, our Implementation Slide show, and also distribute the “Matty” case example showing how a practice debated options and figured out the optimal solution.

11. If learning to screen in an electronic environment is an objective for your audience, ensure, if at all possible, internet access during your talk, and consider asking participants to bring their own lap top. You can then demonstrate PEDS Online and run live trials during your presentation. You can sign up for a 30 child trial at wwww.pedstest.com/online. If you need more trials, please contact us with your trial username and password and we’ll add trials to your account. Or, with online access, participants can, during this part of your talk, sign up for their own trials and generate their own examples.

12. If helpful, you can download our post-test and use that to determine whether attendees have mastered needed content. Feel free to modify the content so that it fits the focus of your training.

13. We can send you a "certificate of participation" template if you'd like to print this out, personalize and provide to each attendee. Please contact us if you need a copy.

14. We are happy to post information about your training (if it is open to other providers in your area). If so please contact us with dates, times, locations, presenter, etc.

Thoughts on training health care providers

Health care providers are often excessively confident in the informal approaches they use (e.g., “trigger questions” to parents, clinical judgment, and milestones checklists such as those built into their age-specific well-child encounter forms). Many providers believe their clinical observations are sufficient and their milestones checklists are accurate because items were drawn from measures such as the Denver-II (which most don’t realize was never validated and is also quite inaccurate). Rarely do health care providers get feedback on how well they are detecting children with problems, so they don't always realize they are missing about 70%! So… for such audiences, consider:

· Start with the “Why Screen” slide show (which will make them quite uncomfortable with a “junk science” approach to early detection).

· Most health care providers use electronic records (or will in the near future), so share with them PEDS Online which includes PEDS, PEDS:DM and the M-CHAT. You can set up a free trial on 30 children at www.pedstest.com/online and demo this during your presentation. If you need extra trials for a presentation, please contact us.

· Be sure to cover billing and coding issues (preferably having explored beforehand how this works for your State’s Medicaid and private payers—who often have different proscriptions for billing). You can use our coding/reimbursement FAQs (or our brochure) as handouts or background information so that you can answer questions that may be asked..

· Print out our page on parenting information resources (such as www.kidshealth.com, Reach Out and Read and Bright Futures as a handout. Health care providers counsel parents at every well visit and they should give parents a copy of their instructions (e.g., about toilet training, discipline, building language skills) and so.... parenting information sites are helpful so that they can simply print relevant information. It is wise to point out that providing parents information that addresses their unique concerns (e.g., parents' comments on PEDS) is most likely to be "taken to heart".

· A major contributor to the often low referral rates from health care providers to early intervention/special education services, is that health care providers are not always familiar with non-medical referral resources. So, make sure you cover these and provide handouts (amended to include local services, toll-free numbers, etc.). It is also helpful to have non-medical providers present briefly about their programs.

· Medical providers can always use a list of professional development information that they can explore on their own. Printing out the professional development/life-long learning page within this module that explains more about various disabilities, how to conduct a neurodevelopmental exam, etc.

· Many health care providers are not comfortable explaining adverse screening test results to families. So, be sure to cover how to do this and include our explaining results guidelines in your handouts.

· When health care clinics have nurse practitioners available, consider presenting (briefly) the notion of “gated screening” through which all children are given a brief measure such as PEDS or PEDS:DM, and then a select group who performed poorly is administered additional, lengthier measures such as the ASQ, Brigance Screens, BDIST, etc.

· If training subspecialty medical providers (e.g., neonatologists, geneticists, cardiologists, etc.), they will need exposure to in-depth, assessment-level measures that track progress and producing age-equivalent scores (since these are better for research studies) such as PEDS:DM Assessment Level, Developmental Profile-III, Brigance Screens, BDIST. But, PEDS should be covered as well to help them identify and address parents needs, encourage participation in services, etc. For this group, please see our NICU/EI Follow-up pages and use those in your presentation.

· Neurodevelopmental and developmental-behavioral (ND/DB) pediatricians have extensive training in child development and mental health, and work with children with a history of prematurity, or who are referred by general pediatricians, special educators, psychologists, etc. Thus, most of their patients have a high index of suspicion and likelihood of substantial problems. Because of their extensive training, i.e., 2- 3 years and the type of patients they see, they definitely don't need screening tests, but rather assessment level measures, like the PEDS:DM Assessment Level (for intake and follow-up) as well as diagnostic tools.

But, ND/DB pediatricians are often in charge of training medical students, graduate level nurses, pediatric, family practice residents, and psychology interns, all of whom, in their professional futures, will probably need to use tools suitable for busy community health care clinics, kindergarten screening initiatives, etc.). Often trainees only have a 1 month rotation in ND/DB pediatrics and will not master, in that period of time, the content of the three-year fellowship that ND/DB pediatricians have completed. So, when working with skilled and sophisticated providers, emphasis is need on tools useful in settings other than ND/DB subspecialty clinics. Helpful is at least brief exposure to PEDS + PEDS:DM Screening Level, followed by the PEDS:DM Assessment Level for detailed monitoring, NICU follow-up, longitudinal research, etc. Guidance for helping DB pediatricians train their trainees, monitor efficiently, etc. is provided in the PEDS:DM Manual (Chapters 8 and 9).

Thoughts on training Non-Medical Providers

Early childhood providers are understandably more interested in milestones type measures especially ones that sample many different skills. Such tools offer a quick benchmark against which to compare progress later in the year, and serve as a starting point for instruction. Nevertheless, encouraging use of PEDS to elicit and address parents’ concerns is also wise because PEDS is the most collaborative of all measures, family-focused, and helps build rapport with parents --increasing their willingness to attend parent-teacher conferences, participate in school events, etc.

1. For day care, preschool and Head Start teachers, start with PEDS:DM (Screening Level). Also it is wise to cover PEDS and possibly the M-CHAT. Some will prefer more in-depth documentation for progress monitoring. If so, also present PEDS:DM Assessment Level (focused on its parent report measurement approach). PEDS Online (which houses PEDS/PEDS:DM/M-CHAT) is worth covering for those with internet access. Emphasis should also be placed on how to advise parents about child-rearing concerns, finding resources, etc.

2. For Early Intervention intake, more detailed measurement is needed. So, present the PEDS:DM Assessment Level (focused on both parent-report and hands-on measurement approach as well on providing age-equivalent scores typically needed for determining percentage of delay). See also our main menu item (NICU follow-up and EI intake). It is also wise to cover at least briefly the PEDS:DM Screening Level and PEDS (since these are more suitable for telephone triage). Also cover the M-CHAT because referrals for autism screening are likely. Exposing these trainees to PEDS Online is wise since it is do-able over the phone and can help provide a swift opinion about whether a child needs further testing.

3. When Early Intervention or other services offer monitoring, most especially for children referred but who did not qualify, presenting the PEDS:DM Assessment Level is ideal since progress can be tracked and the test’s booklet reused with the same child. These services need information on other programs to which they can refer (e.g., Head Start, parent training) when children are not found to be eligible) so including in training handouts, referral and information resources is important. See also our main menu describing NICU follow-up and EI intake.

4. For child welfare/foster care and social workers: A combination of PEDS and the PEDS:DM Screening Level, perhaps along with the M-CHAT is wise for capturing parents’ issues and for skill-focused screening. Because the PEDS:DM can be administered hands-on as well as by parent report, this offers flexibility in measurement that may be needed depending upon caretakers knowledge of the child and the child’s willingness to respond under troubling circumstances (e.g., the foster parents of newly placed children may not know much about a child’s skills but usually can respond to PEDS questions). Because children for whom there are neglect/abuse issues are at very high risk for developmental-behavioral/mental health problems, ideally all should be referred to intervention services. But, given the expense of that, use of measures like the PEDS:DM Assessment Level should be used for all. Nevertheless, on initial encounters (e.g., a home visit where decisions have to be made about the need for placement) there is little time and many other agendas so briefer screens are probably needed and… PEDS:DM Screening items can be added to the PEDS:DM Assessment Level booklets to provide a starting point for further assessment.

§ For therapists and psychologists: Jumping from a failed screen straight into diagnostic evaluations is expensive and sometimes a bottle-neck to services (often violating the 30 - 40 day time frame for conducting evaluations and making placement decisions). Since screens often detect children who are behind but not so far behind that they qualify for special education, it is less expensive and more expedient to follow screens with assessment level tools like the PEDS:DM Assessment Level or Developmental Profile-III—deciding from there which children need diagnostic testing. Such tools, also provide a way to measure children who are not cooperative since they can be administered largely by parent report. Assessment level tools also help indicate starting points, i.e., where a likely basal will occur so that subsequent testing enables a child to attain some success on tasks (which is helpful for establishing behavioral control during testing.

§ For all non-medical providers, encourage them to collaborate with health care providers (e.g., coordinating two-way consent forms, “detailing” clinics with things like a laminated list of local services for each exam room, arranging lunch meetings to talk about screening and referral, distributing and restocking brochures (that include maps on how to get there) to share with families, establishing smooth referral mechanisms—especially encouraging non-medical providers to allow health care services to schedule appointments for families since this is known to increase follow-through with referrals—and facilitating prompt feedback from non-medical services to medical services regarding the status of referrals. Clinicians need to know when families have not kept appointments so they’ll know to repeat messages at the next visit. Also, non-medical providers need encouragement to keep health care providers “in the loop” regarding test results, eligibility for services, etc. Some non-medical services are restricted from making outside referrals (e.g., to Head Start, preschools, parent training) and so health care providers need to know when they should step in.

Early detection “takes a village”! So here are some thoughts for training if you are working with both medical and non-medical providers. The goal is to make sure your presentation helps create a community:

1. Encourage both health care providers AND selected office staff to attend your presentation. Staff are generally responsible for early detection and need to be empowered and informed.

2. Consider seating participants together with non-medical service providers in their specific area/region.

3. Allow at least an hour at the end of your presentation for them to craft an implementation/referral plan (you can use our implementation worksheet to help with that, or if only training health care providers, use the implementation worksheet plus draft workflow plans (from our Implementation slide show).

4. Prompt all to work on two-way consent forms and exchange contact information and figure out how best to communicate.

5. Let one person in each of the small groups you’ve created, take 5 minutes or so to present their plan (so that all can hear and get other ideas)

6. Foment for follow-up among the small groups (e.g., lunch meetings to help institute the plans, develop resource lists to share, etc.).

7. Think about gathering email addresses for the small groups you've created so that you can encourage them to follow-through with each other.

8. Consider having a follow-up conference in 6-9 months to talk about what occurred and what worked, share more ideas, etc.

Thoughts on training researchers and policy-makers

1. Researchers need exposure to the psychometric support for tools. Many are devising research protocols and, frankly, make up questions that lack readability and intelligibility. They too, need encouragement to use quality tools because they have questions proven to work. Researchers need to know about tool options, types of scores rendered, time frames, etc. Some need information on survey/phone interview administration; others need information about outcome measures. Consider using our slide shows, “How to Spot a Quality Screen” and “Research on PEDS and PEDS:DM” (which also demonstrates why standardized, evidence-based questions work well). All will benefit from exposure to PEDS Online and its unique and exportable database. In addition, researchers should be encouraged to read through the research pages on www.pedstest.com and thus become familiar with the empirical underpinnings of our tools.

2. Some researchers analyze data from surveys such as NSCH, CA First Five, etc. in which a closed-ended version of PEDS is used. When working with survey researchers, you will need to focus on the quality of translation, emphasize the value of using at least some open-ended questions [so that they'll know what parents are actually thinking and whether they've answered the question asked(!)], and, ideally pointing to needs-assessment (for which PEDS Online is useful and do-able). Survey researchers benefit greatly from collaboration with others who study various data sets. They might be encouraged to join the Early Detection Discussion List (www.pedstest.com) so they can share ideas.

3. Policy-makers need encouragement to consider the exigencies of settings where screening occurs. Too often those in charge of deciding which tools should be used (e.g., throughout a State or health care plan) are not aware of what is do-able in various types of clinics (e.g., primary care versus early intervention intake). So... decision-makers should always consider offering options among efficient tools, narrowing the list to accurate screens that work in health care settings versus accurate screens (and other measures) more useful for non-medical services--where detailed screens and assessment level measures are more likely to be needed and deployed). See the Table of Tools in this module for options.

All of us do best with choices. We are far more likely to adopt quality measures if we are given options that fit our measurement preferences. In the case of health care settings, some providers are comfortable with parents' concerns as an indicator, others prefer parent-report about skills, some wish for a combination of both parents' concerns and children's skills (which is ideal), and a rare few insist on eliciting skills directly from children. So, we need to help policy-makers understand the constraints of various settings (e.g., that health care providers may only be able to devote 2 - 3 minutes to early detection and developmental-behavioral promotion because clinicians have an enormous range of health issues to cover-- while early intervention professionals have much more time to spend interviewing families, helping them read test questions, administering items hands-on, etc.). So, choices among measures are essential BUT choices should be winnowed to just tools that are proven to be accurate.